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Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ever since a gradual but significant reduction in the estrogenic and progestogenic components of oral contraceptives (OCs) was made, there has been a corresponding decrease in adverse effects associated with the pill. The beneficial effects include prevention of pregnancy, reduction in pelvic inflammatory disease, protection against ovarian/endometrial cancer and benign breast tumors and ovarian cysts, reduction in the occurrence of rheumatoid arthritis among OC users, and regulation of the menstrual cycle. The adverse effects include diseases of the circulatory system (myocardial infarction, venous thromboembolism, subarachnoid hemorrhage, hypertension), possible carcinogenicity (breast, cervix, melanoma), pituitary adenomas, liver disorders, glucose metabolix effects (diabetes), vitamin status alteration, delay in return of menstruation and fertility, and a number of minor side effects (nausea, vomiting). Contraindications to OC use include history of malignancy of the breast or genital tract, venous thromboembolism, cerebrovascular accident, undiagnosed abnormal vaginal bleeding, focal migraine, or familial hyperlipidemia. The following situations require medical assessment before OCs are prescribed, and medical supervision if OCs are prescribed: age 40+, smoking and age over 35, mild hypertension or a history of hypertensive disease of pregnancy (toxemia), epilepsy, diabetes mellitus, history of bouts of depression, history of oligomenorrhea or amenorrhea in nulliparous women, and gallbladder disease. Problems could occur with OC use in the following situations: 1) lactation (ideally, OCs should be withheld until the child is weaned but if not possible, OCs should not be given until lactation is established); 2) drug interaction (other contraceptive form should be used when the patient is taking antibiotics or anticonvulsants); 3) tropical diseases (studies are still underway); 4) adolescence (very young girls should use other contraceptive method until regular menstruation is established); 5) postcoital contraception (limited use of steroids in emergency situation); and 6) hormonal pregnancy tests (use of oral steroids for pregnancy testing is not recommended). The 3 main types of OCs currently used are the combined estrogen and progestagen, the progestagen-only OC, and the triphasic OC. The lowest effective dose of a compound should be used, and healthy women may continue to use OCs for many years.
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PMID:Statement on steroidal oral contraceptives. 1226 73

Norplant, the subdermal levonorgestrel-releasing contraceptive implant, has undergone 28 years of study, clinical trials, and use by the general population. Its great advantage over combined oral contraceptives (OCs) is that it is free of estrogen and thus acceptable for use by many women with contraindications to estrogen. Norplant has few or no apparent effects on cholesterol, phospholipid, or triglyceride levels, and there is no evidence that Norplant use increases cardiovascular risk. Norplant releases a constant dose of levonorgestrel that varies from 350 ng initially to 290 ng after 5 years of use. The levonorgestrel is released directly into the circulation, avoiding the first hepatic passage. Norplant achieves its contraceptive effect by inhibiting the positive feedback exercised by estradiol on the hypothalamus and thus reducing levels of luteinizing hormone and follicle stimulating hormone, by rendering the cervical mucus inhospitable to passage of sperm, and by altering the composition of the endometrial tissue. It has been suggested that Norplant may affect tubal motility, but no studies in support of this hypothesis have been found. Secondary effects of Norplant use include decreased secretion of gonadotropins and consequently decreased frequency of ovulation, impaired luteal function, migraine or tension headaches, and occasionally such effects as facial chloasma or alterations in libido. The most frequent complications are dysfunctional uterine bleeding and irregular staining and spotting or amenorrhea. 70% of women experience such alterations of menstrual pattern with Norplant over 5 years of use. Norplant is contraindicated for diabetic women because of possible alterations in carbohydrate metabolism. Women who use certain antiepileptic or antitubercular drugs or barbiturates that affect the action of levonorgestrel should choose a nonhormonal contraceptive method. Acute or chronic cholestatic hepatic disease is an absolute contraindication. Although studies of the effects of Norplant on breastfeeding have not conclusively demonstrated any risks, the problem of steroid transfer to the infant through the breast milk has not yet been resolved. Several studies have confirmed the contraceptive efficacy of Norplant and calculated its failure rate at 2%, which makes it the second most effective method after sterilization. The rate of ectopic pregnancy is low. The implants should be inserted under aseptic conditions similar to those observed during any surgical procedure. Once the implants are removed, the serum concentrations of levonorgestrel decline rapidly. Most of the steroid is eliminated within days. Fecundity returns in the cycle following removal. 85% of women conceive within the 1st year after removal and 95% do so within 2 years.
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PMID:[Let's talk about Norplant: advances in steroidal contraception]. 1228 84

This is the discussion after a presentation by E. BAULIEU on combined oral contraceptives (ibid; 4(4)1972); it emphasized tumors, blood lipids, and management of typical problems with the pill. It was agreed that the pill does not cause breast cancer, despite the nodules reported in Beagles, but the discussants came to no concensus on the possibility of ovarian cysts and pituitary adenoma. DE GENNES described his 33 cases of vascular accidents in pill users of whom 24 had hyperlipidemia, usually (80%) of the "mixed" type 3 (i.e. high cholesterol and triglycerides). About 2% of women have abnormal plasma lipids, defined as total lipids over 9 g/1, triglycerides over 1.35 g/1, cholesterol over 2.7 g/1. Among the 33 cases, pure hypercholesteremia was underrepresented; premonitory signs (usually migraine) were only present in some cases of cerebrovascular accident, not in cardiac infarction or pulmonary embolism; the parous women had had no trouble in pregnancy. Other topics discussed included diabetes, glucose tolerance tests, hypertension, amenorrhea, menopause, and whether and when to interrupt oral contraception. The conference was concluded with a summary of the status of French legislation on contraception. The French Assembly had not authorized funds for family planning centers, nor for a national office of information, because they considered France too underdeveloped for such an antinatalist policy.
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PMID:[Combined oral contraceptives]. 1230 30

More than 17,000 women are currently under observation as part of a prospective long-term study of women on different contraceptive started in 1968. The women were all white, married, British subjects, aged 25-29 years, who voluntarily agreed to participate. 56% were using oral contraceptives, 25% were using a diaphragm, and 19% were using an IUD. 56,000 woman-years of experience has been obtained. Follow-up has been maintained with an annual lapse rate of .3%. The study included 24 deaths. Women who used oral contraceptives experineced a deficiency of hospital referrals for cancer, benign lesions of the breast, menstraul disorders, duodenal ulcer, and retention cysts of the ovary; and an excess of referrals for cerebrovascular disease, cervical erosion, skin disorders, self-poisoning, migraine, venous thrombosis and embolism, hay fever, gallbladder disease, amenorrhea, and sterility. Women who used a disphragm showed a deficiency of hospital referrals for carcinoma-in-situ, and dysplastic lesions of the cervix uteri and accidental injury; and an excess of referrals for hemorrhoids and cystitis. Women who used an IUD experienced an excess of hospital referrals for anemia, varicose veins and pelvic inflammatory disease. T he outcome of unplanned pregnancies occurring in women using an IUD was unfavorable. The available evidence is insufficient to allow a final balance to be struck between the benefits and risks associated with the new methods of contraception.
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PMID:Prospective long-term study of women on different contraceptives. 1230 39

Many factors should be considered when an episodic migraine worsens and becomes chronic. Prolactin (PRL) was linked to the origin of pain in patients with microprolactinomas who developed different types of headaches. Our team carried out studies on 27 patients with a background of episodic headaches that became chronic. The patients were evaluated by means of a general examination, a neurological examination and a hormonal profile. Of the 27 patients, 7 of them had an increased level of prolactinaemia. All the patients were women, ranging from 17 to 57 years of age. Four of them had a pure form of migraine without aura, whereas 3 patients had both migraines without aura and tension-type headaches. They suffered from headache for a period ranging from 3 to 32 years and their headache became chronic 4-12 months prior to the visit. Their headache did not change in type, but only in severity and frequency. Two patients had no symptoms referable to high PRL levels; 4 patients had irregular menses or amenorrhoea. One of these patients also suffered galactorrhoea and two of these patients had a microprolactinoma at MRI; one patient was using estroprogestinic drugs, so her menstrual alteration could not be considered. The patients were followed-up for a period of 6-16 months. Six patients responded favourably after being treated with cabergoline, although some had already tried other drugs, which, however, had no effect on their headache. One patient improved after ceasing to take estroprogestinic, in spite of increased levels of PRL. Therefore, on this basis, PRL levels should always be considered when headache worsens. It is an adjunctive worsening factor, which can be easily eliminated.
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PMID:High prolactin levels as a worsening factor for migraine. 1653 25

A radiation dose lower than what had previously been recommended was given to a case of intrasellar germinoma in a 17-year-old patient who suffered from migraine-like headache for 2 years, amenorrhoea for 3 months and a body-weight loss of 10 kg over 4 months. Baseline assessment of pituitary hormone reserve was within the lower limits of the normal range, except for an elevated serum prolactin level (PRL). Magnetic resonance imaging (MRI) showed an abnormal, slightly enhanced mass in the pituitary fossa, extending along the pituitary stalk and to the hypothalamus. Transsphenoidal removal of the intrasellar part of the tumour was performed and microscopic sections of the surgical specimens revealed a pure germinoma. Adjunctive radiation therapy (RT) was given 3 weeks after surgery. A total dose of only 27 Gy was delivered to this patient. The patient's menstrual cycles resumed in 4 months. Repeated MRI follow-up showed no recurrence of the tumour.
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PMID:Intrasellar germinoma treated with low-dose radiation. 1667 Aug 38

Epilepsy, bipolar disorder, and migraines are common disorders that are often associated with disturbances in menstrual function in adolescent girls. Women with untreated epilepsy are more likely to have irregular menstrual cycles than are nonepileptic controls, indicating that the disease itself plays a role in the etiology of these reproductive abnormalities. In addition, many girls with these disorders require chronic maintenance treatment with agents that may perturb the hypothalamic-pituitary-ovarian axis. Valproate is a highly effective antiepileptic drug used widely to treat epilepsy, bipolar disorder, and migraines. Valproate induces features of the polycystic ovary syndrome (PCOS) in approximately 7% of women. Girls with epilepsy, and possibly bipolar disorder, appear particularly susceptible to developing PCOS features on valproate, perhaps on account of the relative immaturity of their hypothalamic-pituitary-ovarian axes. Antipsychotics are highly effective drugs used widely to treat adolescents with bipolar disorder, psychotic disorders, and behavioral disturbances. Some, but not all of the antipsychotic, induce hyperprolactinemia, which may result in oligo- or amenorrhea. Prolonged amenorrhea in association with hyperprolactinemia incurs significant risks for bone health in adolescent girls. Because of the potential reproductive health risks associated with use of specific antiepileptic drugs and selective antipsychotics, these agents are vital treatments for adolescents with severe illnesses. Use of these agents should be considered and weighed against the risk of using alternative agents, which have their own side effects, or not treating these serious neurologic and psychiatric disorders.
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PMID:Menstrual cycle dysfunction associated with neurologic and psychiatric disorders: their treatment in adolescents. 1857 28

Surveys show that most women desire a change in their menstrual pattern in the sense that they would prefer less menstruations or even amenorrhea. On this behalf, there is no difference between women having spontaneous natural cycles and women taking the pill. The main reasons are less menstrual bleedings, better hygienic conditions, a better quality of life and less blood loss. In women wanting regular monthly periods, the opinion is dominant that suppression of menstrual bleedings is "unnatural". It is therefore primordial to inform women that contraceptive safety is even increased in users following the long-cycle principal and that a fertility decrease has not to be feared. The benefit of the long-cycle OC is a reduction of the hormonal fluctuations induced by the pill-free interval with its consecutive somatic and mental symptoms, as well as an increased contraceptive safety. The following cycle- and menstruation-dependent symptoms as listed as an indication for the long-cycle use: Endometriosis, hypermenorrhea, dysmenorrhea, hemorrhagic diathesis, uterine fibroma, polyzystic ovary syndrome, migraine due to estrogen-deficiency in the pill-free interval as well as premenstrual syndrome.
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PMID:[Long-cycle treatment in oral contraception]. 1918 Apr 30

The fruit of Tetradium ruticarpum is widely used in healthcare products for the improvement of blood circulation, headache, abdominal pain, amenorrhea, chill limbs, migraine, and nausea. A new quinolone, 2-[(6Z,9Z)-pentadeca-6,9-dienyl]quinolin-4(1H)-one (1), has been isolated from the fruits of T. ruticarpum, together with eleven known compounds. The structure of the new compound was determined by NMR and MS analyses. Rutaecarpine (4), evodiamine (5), and skimmianine (7) exhibited inhibition (IC(50) < or = 20.9 microM) of O2(.-) generation by human neutrophils in response to N-formyl-L-methionyl-L-leucyl-L-phenylalanine/cytochalasin B (fMLP/CB). In addition, 1, evocarpine (2), 4, 7, and evodol (8) inhibited fMLP/CB-induced elastase release with IC(50) values < or =14.4 microM.
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PMID:A new quinolone and other constituents from the fruits of Tetradium ruticarpum: effects on neutrophil pro-inflammatory responses. 2065 72

Hyperprolactinemia is a condition characterised by an increase of prolactin blood levels (more than 100-200 ng/ml). It is the most common endocrine disorder of the hypothalamic-pituitary axis. The clinical characteristics of the headache-hyperprolactinemia-hypophyseal-adenoma association are discussed, the various diagnostic and treatment possibilities are explored and the etiology of the headache is considered in the light of several pathogenetic possibilities. We present two cases. (1) A 35-year-old woman suffering from chronic tension-type headache interspersed with occasional episodes of migraine without aura (as defined by the International Headache Society criteria). She had also suffered menstrual cycle alterations since the age of 16. At the age of 30 she developed amenorrhea with hyperprolactinemia. Computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a median-left intrasellar mass. Treatment with cabergoline resulted in complete resolution of both types of headache and the menstrual cycle and prolactin levels returned to normal. The therapy also reduced the volume of the tumour. (2) The second case relates to a 47-year-old man who had been suffering from tension-type headaches for almost 3 months. The patient had never previously suffered from headaches. CT and MRI scans showed a large sellar and suprasellar lesion with raised serum prolactin levels. Treatment with cabergoline had significantly reduced the prolactin levels and had also improved the patient's headaches. High-resolution CT, with and without contrast, or MRI is necessary to visualise microprolactinomas (and other sellar lesions) and confirm the diagnosis.
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PMID:How to investigate and treat: headache and hyperprolactinemia. 2263 80


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